"Fighting for patients’ lives should not include fighting to get paid," says Envision Healthcare CEO Jim Rechtin.
Envision Healthcare—a Nashville-based, private-equity-owned healthcare provider with over $14 billion in annual revenue—has filed a lawsuit demanding UnitedHealthcare pay its bills and fairly reimburse clinicians for providing emergency care to patients across the country.
Envision’s suit claims United prioritized its own profits over patient well-being and supporting doctors and other healthcare practice providers providing emergency room care. The lawsuit points to several incidents including a 31-year-old man requiring an emergency appendectomy and a 2-month-old baby with unexplained episodes of choking, vomiting, and turning blue, suggesting United subjected these and other claims to a "pre-payment review" before eventually denying the claims.
"After pushing Envision clinicians out-of-network in January 2021, United began a routine and systematic denial of commercial claims related to emergency room care for its members with the highest acuity — patients who sought care for life-threatening illnesses and complications," Jim Rechtin, Envision Healthcare CEO, said in an email release detailing the lawsuit. "United’s scheme to deny patient claims violates federal law. Improperly withholding payment from the very frontline clinicians who treated their members in their most acute time of need is, in my opinion, cold, callous, and inhumane."
Envision Healthcare has been struggling financially this year, reporting a loss of $26 million for the second quarter’s adjusted EBITDA, according to a Bloomberg report, which is a decline from the gain of $221 million for the second quarter of 2021. Envision’s losses were the result of growing labor costs, a change in the way private and government insurance plans pay for services, and a separate contract fight with United.
Investors and lenders are unhappy with some recent moves Envision Healthcare has made to secure new financing as it works to improve operations, including moving some valuable assets away from its creditors. The No Surprises Act, which took effect in January, is another area of frustration for Envision Healthcare as it will limit how much patients can be billed for out-of-network emergency services.
The suit against United specifically references emergency department services, claiming that United "didn’t pay a penny" for the emergency treatment provided to the patients previously referenced.
"Only United, with its $17.3 billion in profits in 2021 and 1,000% stock price increase for its owners, would have the audacity to refuse reimbursement to the clinicians providing the life-saving care to its own members," Rechtin said. "Envision’s clinicians will continue to guide their patients through life’s toughest moments. Fighting for their patients’ lives should not include fighting to get paid."
Amanda Schiavo is the Finance Editor for HealthLeaders.